目的 基于鼻功能与应激反应评估低温等离子消融术（low temperature plasma ablation,LTPA）在中青年鼻腔鼻窦内翻性乳头状瘤（sinonasal inverted papilloma,SNIP）患者中的应用价值。方法 回顾性收集2019年12月—2024年1月张家港市中医医院收治的91例中青年患者作为研究对象,按照不同手术方案分为对照组（45例）、观察组（46例）,对照组接受鼻内镜手术,观察组接受鼻内镜手术+LTPA。比较两组临床疗效、手术指标、应激反应指标[肾上腺素（epinephrine,E）、去甲肾上腺素（norepinephrine,NE）、皮质醇（cortisol,Cor）]、鼻功能、鼻腔鼻窦结局测试20项（sinonasal outcometest-20,SNOT-20）评分、术后并发症发生和术后1年复发情况。结果 观察组总有效率（95.65%）明显高于对照组（82.22%）;观察组术中出血量、术后渗血时间、术腔恢复时间均低于对照组;术后1、3 d观察组Cor、E、NE低于对照组;术后3个月观察组纤毛清除率、纤毛清除速度高于对照组,鼻气道阻力、糖精清除时间、SNOT-20评分低于对照组;观察组并发症发生率与对照组比较,差异均无统计学意义;观察组术后1年复发率（2.17%）低于对照组（13.33%）。结论 中青年SNIP患者接受LTPA治疗效果明显,可改善患者应激反应、鼻功能,并降低术后1年复发率。
Abstract
Objective To evaluate the application value of low temperature plasma ablation (LTPA) in young and middle-aged patients with sinonasal inverted papilloma (SNIP) based on nasal function and stress response. Methods A retrospective collection of 91 young and middle-aged SNIP patients admitted to Zhangjiagang Hospital of Traditional Chinese Medicine from December 2019 to January 2024 was conducted as the research subjects. They were divided into the control group (45 cases) and the observation group (46 cases) according to different surgical plans. The control group received nasal endoscopic surgery, and the observation group received nasal endoscopic surgery +LTPA. The clinical efficacy, surgical indicators, stress response indicators [epinephrine (E), norepinephrine (NE), cortisol (Cor)], nasal function, sinonasal outcometest-20(SNOT-20) scoring, and the occurrence of postoperative complications and recurrence one year after the operation. Result The total effective rate of the observation group was 95.65%, significantly higher than that of the control group (82.22%). the intraoperative blood loss, postoperative bleeding time and surgical cavity recovery time in the observation group were all lower than those in the control group. On postoperative day 1 and 3, the levels of Cor, E and NE in the observation group were lower than those in the control group. Three months after the operation, the ciliary clearance rate and ciliary clearance speed in the observation group were higher than those in the control group, while the nasal airway resistance, saccharin clearance time and SNOT-20 score were lower than those in the control group. The incidence of complications in the observation group was 6.52%, compared with 13.33% in the control group, and the differences were not statistically significant. The one-year recurrence rate in the observation group was 2.17%, which was lower than that 13.33% in the control group. Conclusion LTPA treatment has a significant effect on young and middle-aged patients with SNIP. It can improve the stress response and nasal function of patients and reduce the recurrence rate one year after the operation.
关键词
鼻功能 /
应激反应 /
低温等离子消融术 /
中青年 /
鼻腔鼻窦内翻性乳头状瘤
Key words
nasal function /
stress response /
low-temperature plasma ablation /
middle-aged and young people /
inverted papilloma of the nasal cavity and paranasal sinuses
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参考文献
[1] EIDE JG, WELCH KC, ADAPPA ND, et al.Sinonasal inverted papilloma and squamous cell carcinoma: contemporary management and patient outcomes[J]. Cancers (Basel), 2022, 14(9): 2195.
[2] COUTINHO G, MARQUES J, LEAL M, et al.Surgical outcomes of sinonasal inverted papilloma: a 17 year review[J]. Braz J Otorhinolaryngol, 2020, 86(3): 315-320.
[3] TUŞALIU M, MOGOANTĂ CA, IANCU C, et al. Sinonasal inverted papilloma from diagnosis to treatment - a narrative review[J]. Rom J Morphol Embryol, 2024, 65(4): 599-607.
[4] 吴宗泽, 高峰, 陆良钧, 等. 低温等离子下鼻甲射频消融术对慢性肥厚性鼻炎患者鼻腔结构、鼻黏液纤毛清除功能及气道阻力的影响[J]. 转化医学杂志, 2024, 13(8): 1189-1193.
[5] 郭玉德. 现代耳鼻咽喉实用手术学[M]. 武汉: 湖北科学技术出版社, 2009.
[6] 常媛, 邱志利, 蒋晓平, 等. 鼻内镜手术联合低温等离子射频消融术治疗鼻腔鼻窦内翻性乳头状瘤的疗效及对术后复发的影响[J]. 解放军医药杂志, 2021, 33(01): 31-34.
[7] MULLOL J, LUND VJ, WAGENMANN M, et al.Mepolizumab improves sense of smell in severe chronic rhinosinusitis with nasal polyps: SYNAPSE[J]. Rhinology, 2024, 62(3): 320-329.
[8] 赵慧娜, 李玉杰, 杨长君, 等. 术后血清MMP-2、SCCA1表达水平对鼻腔鼻窦内翻性乳头状瘤术后复发的预测价值[J]. 实用癌症杂志, 2024, 39(04): 547-550, 561.
[9] LIU Q, WENG C, ZHENG H, et al.Endoscopic modified medial maxillectomy for inverted papilloma of the maxillary sinus[J]. J Craniofac Surg, 2022, 33(1): e71-e73.
[10] WANG C, ZHAO Y, LI C, et al.Meta-analysis of low temperature plasma radiofrequency ablation and CO2 laser surgery on early glottic laryngeal carcinoma[J]. Comput Math Methods Med, 2022, 2022: 3417005.
[11] SUN M, XU G, ZHANG G.Low temperature plasma ablation device for minimally invasive surgery[J]. Rev Sci Instrum, 2023, 94(1): 014101.
[12] 赵春蓉, 税磊, 余文兴, 等. 鼻内镜下治疗鼻腔鼻窦内翻性乳头状瘤的临床及预后分析[J]. 肿瘤预防与治疗, 2021, 34(9): 810-816.
[13] 张连生. 低温等离子射频消融术联合鼻内镜手术治疗鼻腔鼻窦内翻性乳头状瘤的效果观察[J]. 中国实用医刊, 2023, 50(23): 63-66.
[14] 徐莲, 戴润芝, 李堂, 等. 鼻内镜下低温等离子射频消融术联合耳科电钻治疗鼻腔鼻窦内翻性乳头状瘤[J]. 湖北医药学院学报, 2025, 44(2): 156-159, 189.
[15] SU B, HAN Q, XI X, et al.Effect of modified endoscopic sinus surgery combined with middle turbinate resection on olfactory function and stress response in patients with refractory chronic rhinosinusitis with nasal polyps[J]. Am J Transl Res, 2022, 14(2): 1279-1287.
[16] TARIQ MD, HURJKALIANI S, ZULFIQAR E, et al.Efficacy and safety of middle turbinate resection versus preservation in patients with chronic rhinosinusitis: a pilot systematic review and meta-analysis[J]. Ann Med Surg (Lond), 2025, 87(4): 1780-1786.
[17] WANG H, ZHOU J, SHI L, et al.Increased neutrophil infiltration and epithelial cell proliferation in sinonasal inverted papilloma compared to contralateral nasal polyps[J]. Am J Rhinol Allergy, 2022, 36(5): 583-590.
[18] QU J, SUN Y, LIANG N, et al.Histopathological characteristics and inflammatory cell infiltration in sinonasal inverted papilloma[J]. Am J Rhinol Allergy, 2025, 39(1): 21-31.
[19] ALOTAIBY F, ISLAM MN, BHATTACHARYYA I, et al.Carcinosarcoma arising from inverted papilloma in a patient with history of radiotherapy for sinonasal squamous cell carcinoma[J]. Am J Case Rep, 2020, 21: e921827.
[20] OLSSON SE, PEÑA R. Endoscopic removal of sinonasal inverted papilloma originating from the posterior ethmoid cavity[J]. Case Rep Otolaryngol, 2025, 2025: 8389174.
[21] 杨晓宇, 黄丹. 鼻内镜手术联合低温等离子鼻甲射频消融术治疗慢性鼻窦炎患者的效果及对术后鼻通气功能及变态反应的影响[J]. 临床医学研究与实践, 2024, 9(3): 87-91.
基金
苏州市科技发展计划（医疗卫生科技创新）项目（SKYD2022046）
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